Risk Of Long-term Complications Research Articles

Transient cognitive impairment in the acute phase of stroke – prevalence, risk factors and influence on long-term prognosis in population of patients with stroke (research study – part of the PROPOLIS study)

BackgroundCognitive impairment is a common complication of the acute phase of stroke, which can be transient and resolve while still in the hospital. This study evaluated the prevalence and risk factors for transient cognitive impairment and their impact on long-term prognosis in a population of acute-phase stroke patients.MethodsConsecutive patients admitted to a stroke unit with acute stroke or transient ischemic attack were screened twice for cognitive impairment using the parallel version of Montreal Cognitive Assessment: the first time between the first and third day and the second time between the fourth and seventh day of hospitalization. If the second test score increased by two or more points, transient cognitive impairment was diagnosed. Patients were scheduled for follow-up visits three and 12 months after stroke. Outcome assessment included place of discharge, current functional status, dementia, or death.ResultsFour hundred forty-seven patients were included in the study, 234 (52.35%) were diagnosed with transient cognitive impairment. Delirium was the only independent risk factor for transient cognitive impairment (OR 2.417, 95%CI 1.096–5.333, p = 0.029). In the analysis of effects on three- and twelve-month prognosis, patients with transient cognitive impairment had a lower risk of hospital or institution stay 3 months after stroke compared with patients with permanent cognitive impairment (OR 0.396, 95%CI 0.217–0.723, p = 0.003). There was no significant effect on mortality, disability or risk of dementia.ConclusionsTransient cognitive impairment, which often occurs in the acute phase of stroke, does not increase the risk of long-term complications.

Long-term complications after tonsil surgery: an analysis of 54,462 patients from the Swedish Quality Register for Tonsil Surgery.

This study aims to evaluate long-term complications after tonsil surgery using an exploratory retrospective cohort study design based on data from the Swedish Quality Register for Tonsil Surgery (SQTS). All patients registered in the SQTS between 1 January 2009 and 31 May 2021 were eligible for the study. In this study, a long-term complication is defined as any complication persisting for a minimum of 6 months after surgery. The definition of a complication was based on individual patient reports, provided in a free text format, of any remaining issues 6 months after tonsil surgery. Complications were categorized as follows: disturbed taste or sense of smell, dysphagia, miscellaneous and general symptoms and signs, miscellaneous throat problems, pain or discomfort in the mouth or throat, problems with jaws or teeth, problems with the ears or hearing, problems with the nose or sinuses, problems with throat secretions or throat clearing, problems with voice or speech, and sensory symptoms. A multivariable logistic regression analysis was used to identify independent predictors of long-term complications. In total, 54,462 patients were included in the study. A total of 3,780 patients (6.9%) reported one or more long-term complications. The most frequent long-term complications, with a plausible connection to the surgery, were found in the following categories: pain or discomfort in the mouth or throat (1.9%), problems with throat secretions or throat clearing (0.8%), dysphagia (0.6%), and problems with voice or speech (0.6%). Tonsillotomy was associated with a lower risk of long-term complications than tonsillectomy. This study suggests that subjective long-term complications after tonsil surgery, in general, are relatively common (6.9%). However, complications with a plausible connection to the surgery were less common (4.0%), and specific complications seemed to be relatively rare, with no single specific problem reaching a prevalence of ≥0.6%.

Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in public hospitals of Sidama Region, Sidama, Ethiopia, 2022: an unmatched case-control study.

neonatal jaundice appears in most neonates as "physiological jaundice" in the first few weeks of life; however, pathological jaundice is associated with an increased risk of long-term complications and mortality only a few studies have been conducted on the determinants of neonatal jaundice in Ethiopia. The aim of this study was to identify the determinants of neonatal jaundice (pathological) among neonates admitted to neonatal intensive care units in Sidama Region general and referral public hospitals. a hospital-based unmatched case-control study was conducted among 270 neonates in public hospitals of Sidama Region from June 23 to August 8, 2022. We used a pre-tested interviewer-administered questionnaire and collected by open data kit (ODK) then the data was downloaded and exported to Microsoft Excel worksheets (XLS) and imported to SPSS version 26 for further analysis. Bi-variable logistic regression analysis was performed. Variables with a P-Value of less than 0.25 were included in multivariable logistic regression. Multi-variable logistic regression was performed and Adjusted Odds ratio (AOR) with a 95% confidence interval was computed and statistical significance was declared at a p-value <0.05. a total of 270 neonates with mothers (90 cases and 180 controls) with a response rate of 100% were included in this study. Factors significantly increased the odds of developing neonatal jaundice were multiparty (AOR=2.869(95%CI 1.426-5.769)), prolonged duration of labor (AOR=4.618(95%CI 1.689 - 12.625)). ABO incompatibility (AOR=3.362(95%CI, 1.185 - 9.537)). Preterm (AOR=2.936(95%CI, 1.2456.923)), birthasphyxia (AOR=2.278(95%CI,1.1454.531)) and polycythemia (AOR=3.397(95%CI, 1.147-10.061)). in this study multiparty, prolonged duration labor, ABO incompatibility, preterm gestational age, birth asphyxia, and polycythemia were factors that significantly increased the odds of developing neonatal jaundice.

A Study To Assess the Knowledge and Self-Care Practices on Gestational Diabetes MELLITUS Among Antenatal Women

AbstractGestational Diabetes Mellitus is a public health concern and one of the causes of maternal and fetal mortality and morbidity.Gestational diabetes is one of the most common health issue that can occur during pregnancy.it happens when the mother isfirst diagnosed with diabetes during the pregnancy. The minimizing factors for gestational diabetes are adequate knowledgeabout the condition for early detection and treatment; healthy practices on diet and physical activeness. Awareness of thecondition among antenatal women will translate into adoption of a healthy lifestyle, better health-seeking pattern, better selfcarepractice, which prevent acute complications and reduce the risk of long-term complications and promote pregnancyoutcome.

Keratoprosthesis

ABSTRACT Keratoprosthesis (Kpro) is considered as the last resort for bilateral endstage corneal blindness. Commonly performed Kpros are Boston Type 1 and 2 Kpros, Modified Osteoodonto Kpro, OsteoKpro, and Pintucci Kpro. These procedures require an exclusive setup, longterm follow-up, and postKpro care. There is always a significant long-term risk of complications of infection or extrusion of the device with these procedures as the keratoprosthesis is a foreign body. Most common complications of Kpro procedure are postoperative glaucoma, retroprosthetic membrane, sterile melts, and endophthalmitis.

Development of Celiac Disease Therapeutics: The Sixth Gastroenterology Regulatory Endpoints and the Advancement of Therapeutics Workshop

Development of Celiac Disease Therapeutics: The Sixth Gastroenterology Regulatory Endpoints and the Advancement of Therapeutics Workshop

Outbreak of myopia in pediatrics : management, prevention and treatment

The worldwide incidence and prevalence of myopia has increased. The age of onset of this refractive disorder has inversely decreased. In addition to genetic and familial factors, environmental factors related to a sedentary lifestyle and activities in highly solicited near vision seem to have an impact on the development of axial myopia, that is an early and non-reversible elongation of the eyeball. Prevention of the development of myopia in pediatrics through simple daily measures plays therefore a fundamental role. In addition, pharmacological treatments, and specific optical treatments for controlling myopia have shown encouraging results in reducing the risk of long-term complications of progressive myopia, that is increased risk of developing cataract, glaucoma, retinal detachment, or maculopathy.

Understanding Eating Disorders in Children and Adolescent Population

Eating disorders (EDs) are increasingly recognized in children and adolescents. Anorexia nervosa (AN) and bulimia nervosa (BN) are less common in children and adolescents than adults, but both disorders can occur in this age group. Binge-eating disorder (BED) is the most common ED in children and adolescents and is more prevalent in females than males. EDs may present differently in children and adolescents than in adults, and parents or caregivers may be the first to notice changes in eating patterns or body weight. Diagnostic criteria for EDs in children and adolescents include disturbances in eating behavior, weight or shape concerns, and significant distress or impairment in social, academic, or occupational functioning.Multidisciplinary approaches are recommended for treating EDs in children and adolescents, including medical management, nutritional counseling, and psychological interventions. Evidence-based treatments for AN and BN include family-based therapy, cognitive-behavioral therapy, and interpersonal psychotherapy. Cognitive-behavioral therapy and interpersonal psychotherapy are recommended for children and adolescents with BED. Hospitalization may be necessary in severe cases.Early identification and intervention are crucial for improving treatment outcomes and reducing the risk of long-term complications. Treatment approaches should be tailored to developmental and cultural needs and involve a multidisciplinary team. Continued research is needed to improve early detection, prevention strategies, and treatments for this vulnerable population. EDs in children and adolescents are a significant public health concern that can have serious physical and psychological consequences. It is important for healthcare providers and caregivers to be aware of the signs and symptoms of EDs in young people and to seek prompt and appropriate treatment

Ovarian Hyperstimulation Syndrome: A Case Report

BackgroundOvarian hyperstimulation syndrome is a rare, life-threatening obstetric emergency. Early recognition and prompt treatment of ovarian hyperstimulation syndrome are essential owing to the risk of long-term complications associated with this condition. Case PresentationA 30-year-old female presented to the emergency department with a chief complaint of abdominal pain. After assessment and diagnostic testing, she was diagnosed as having ovarian hyperstimulation syndrome. The patient was admitted for 24-hour observation. The patient was discharged home with instructions to follow up with an outpatient reproductive medicine clinic. One month after her visit to the emergency department, the patient has not had any complications related to the diagnosis. ConclusionThis manuscript outlines the case of a patient presenting to the emergency department with ovarian hyperstimulation syndrome that was promptly recognized and treated. It is important for emergency nurses to quickly identify the risk factors and clinical presentation of ovarian hyperstimulation syndrome to decrease the risk of long-term complications.

Plasma Prostaglandin E2 Metabolite Levels Predict Type 2 Diabetes Status and One-Year Therapeutic Response Independent of Clinical Markers of Inflammation.

Over half of patients with type 2 diabetes (T2D) are unable to achieve blood glucose targets despite therapeutic compliance, significantly increasing their risk of long-term complications. Discovering ways to identify and properly treat these individuals is a critical problem in the field. The arachidonic acid metabolite, prostaglandin E2 (PGE2), has shown great promise as a biomarker of β-cell dysfunction in T2D. PGE2 synthesis, secretion, and downstream signaling are all upregulated in pancreatic islets isolated from T2D mice and human organ donors. In these islets, preventing β-cell PGE2 signaling via a prostaglandin EP3 receptor antagonist significantly improves their glucose-stimulated and hormone-potentiated insulin secretion response. In this clinical cohort study, 167 participants, 35 non-diabetic, and 132 with T2D, were recruited from the University of Wisconsin Hospital and Clinics. At enrollment, a standard set of demographic, biometric, and clinical measurements were performed to quantify obesity status and glucose control. C reactive protein was measured to exclude acute inflammation/illness, and white cell count (WBC), erythrocyte sedimentation rate (ESR), and fasting triglycerides were used as markers of systemic inflammation. Finally, a plasma sample for research was used to determine circulating PGE2 metabolite (PGEM) levels. At baseline, PGEM levels were not correlated with WBC and triglycerides, only weakly correlated with ESR, and were the strongest predictor of T2D disease status. One year after enrollment, blood glucose management was assessed by chart review, with a clinically-relevant change in hemoglobin A1c (HbA1c) defined as ≥0.5%. PGEM levels were strongly predictive of therapeutic response, independent of age, obesity, glucose control, and systemic inflammation at enrollment. Our results provide strong support for future research in this area.

Abstract PR007: Candidate antigens for a ductal carcinoma in situ vaccine, essential for breast cancer cell survival across multiple subtypes, are immunogenic in DCIS and IBC

Abstract Vaccine therapy may to destroy the current ductal carcinoma in situ (DCIS), prevent recurrence, and have little risk of long-term complications. One of the limitations for a DCIS vaccine is identifying appropriate antigens which, when targeted, may be able to treat DCIS and prevent development of IBC. In this study, we identified proteins that were overexpressed in both DCIS and IBC tumors across fifteen human Geo and Array Express data sets. From the 68 candidate proteins, twelve proteins expression was necessary for cancer cell survival across breast cancer subtypes using a high throughput siRNA screen. We chose candidates that increased apoptosis and decreased cell survival in human HER2 positive (HER2), triple negative (TN), and hormone receptor positive HER2 negative (HR) human breast cancer cell lines with decreased expression of the target protein. Twelve proteins (AURKA, KIF11, NDC80, RRM2, SDC1, UBE2C, HJURP, CENPA, CENPF, HIST2H2AA3, KRT8, and TOP2A) were the twelve antigens developed for the vaccine. All twelve targets were immunogenic in women with DCIS and IBC as compared to age matched control women. For example, autoantibodies to four of the antigens (AURKA, NDC80, KRT8, and RRM2) predicted women with DCIS with AUC 0.69 (p=0.005 95% CI 0.56 to 0.80) and IBC with AUC 0.79 (p&amp;lt;0.001 95% CI 0.66 to 0.90) as compared to age matched control women in a discovery set of 59 DCIS patients, 37 IBC patients, and 43 control women. In an independent validation set of serum samples of 50 DCIS, 60 IBC, and 50 control patients, autoantibodies to the four candidate antigens could predict women with DCIS with AUC 0.62 (p=0.04, 95% CI 0.51 to 0.73) and IBC with AUC 0.69 (p&amp;lt;0.001, 95% CI 0.60 to 0.79). Autoantibodies to the four DCIS antigens could identify each subtype of breast cancer subtype as compared to control, HR+(n=20 patients) with AUC 0.69 (p=0.01, 95% CI 0.55 to 0.83), HER2+ (n=20 patients) with AUC 0.70 (p=0.01, 95% CI 0.55 to 0.84), and TN (n=20 patients) with AUC 0.74 (p=0.002, 95% CI 0.61 to 0.87). All these were IgG autoantibodies suggest pre-existing T cells that recognize the candidate antigens because Ig class switching from IgM to IgG requires antigen-specific T cells. These twelve candidate antigens, overexpressed in human breast cancer, are also overexpressed in the TgMMTV-neu and C3(1)Tag transgenic mouse mammary tumor models of breast cancer. Vaccination with human MHC Class II predicted epitopes from KRT8, conserved between mouse and human, inhibited tumor growth in TgMMTV-neu mice by 47% and C3(1)Tag by 62%. The KRT8- specific IFN-g immune response developed was associated with lower tumor volume with mice vaccinated with the human MHC Class II Th1 KRT8 epitopes with the KRT8-specific IFN-g immune response associated with smaller tumors in TgMMTV-neu mice (R2= 0.64, p=0.02). We plan to develop these antigens in a multi-antigen DCIS vaccine that may be able to destroy DCIS and prevent breast cancer across all breast cancer subtypes. Citation Format: Sasha E. Stanton, Jason Schlumbohm, Mary L. Disis. Candidate antigens for a ductal carcinoma in situ vaccine, essential for breast cancer cell survival across multiple subtypes, are immunogenic in DCIS and IBC [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr PR007.

Risk factors for recurrence and complications after laparoscopic repair of incisional hernia using a double-layered ePTFE/PP mesh: results of a retrospective study.

The objective was to analyse, risk factors for recurrence (primary outcome) and complications (secondary outome) after the implantation of a double layer ePTFE (expanded PolytTetraFluoroEthylene) / PP (PolyPropylene) mesh to treat incisional hernias (IH) using the Intraperitoneal Onlay Mesh (IPOM) technique. We included all elective laparoscopic IH repairs with intraperitoneal placement of a ePTFE / PP mesh (Relimesh® - Herniamesh S.r.l.) from January 1, 2010 to December 31, 2017 at Humanitas Mater Domini Clinical Institute in Castellanza (Italy) and at the Centre for Minimally Invasive Surgery of Niš (Serbia). Performance was defined as long-term recurrence rate. A total of 284 patients were enrolled. According to the European Hernia Society (EHS) hernias were classified as: W1 (<4 cm) 60.29%, W2 (≥4-10 cm) 35.02% and W3 (≥10 cm) 4.69%; medial 90.85%, lateral 6.69%, both medial and lateral 2.11%. Average follow-up was 48 (11-110) months. The 30-days complication rate was 4.23%. Hernia recurrence rate was 3.36%. Long-term complication rate was 6.34%. At multivariable analysis, an increased risk of short-term complications was associated to chronic obstructive pulmonary disease (COPD) (OR 7.59 [2.23-25.83], P=0.001); an increased risk of long-term complications was associated to diabetes (OR 6.21 [1.80-21.42], P=0.004), an increased risk of recurrence was correlated to COPD (OR 13.40 [1.36-131.9], P=0.026) and hernia defects larger than 6 cm (OR 19.2 [1.12-329.9], P=0.042). Elective laparoscopic IH repair with a double-layered ePTFE/PP mesh is safe and effective. Compliance with indications and preoperative patients evaluation are essential to improve outcomes.

Factors associated with preference of choice of aortic aneurysm repair in the PReference for Open Versus Endovascular repair of AAA (PROVE-AAA) study.

Patients can choose between open repair and endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). However, the factors associated with patient preference for one repair type over another are not well-characterized. Here we assess the factors associated with preference of choice for open or endovascular AAA repair among veterans exposed to a decision aid to help with choosing surgical treatment. Across 12 Veterans Affairs hospitals, veterans received a decision aid covering domains including patient information sources and understanding preference. Veterans were then given a series of surveys at different timepoints examining their preferences for open versus endovascular AAA repair. Questions from the preference survey were used in analyses of patient preference. Results were analyzed using χ2 tests. A logistic regression analysis was performed to assess factors associated with preference for open repair or preference for EVAR. A total of 126 veterans received a decision aid informing them of their treatment choices, after which 121 completed all preference survey questions; five veterans completed only part of the instruments. Overall, veterans who preferred open repair were typically younger (70years vs 73years; P= .02), with similar rates of common comorbidities (coronary disease 16% vs 28%; P= .21), and similar aneurysms compared with those who preferred EVAR (6.0cm vs 5.7cm; P= .50). Veterans in both preference categories (28% of veterans preferring EVAR, 48% of veterans preferring open repair) reported taking their doctor's advice as the top box response for the single most important factor influencing their decision. When comparing the tradeoff between less invasive surgery and higher risk of long-term complications, more than one-half of veterans preferring EVAR reported invasiveness as more important compared with approximately 1 in 10 of those preferring open repair (53% vs 12%; P< .001). Shorter recovery was an important factor for the EVAR group (74%) and not important in the open repair group (76%) (P= .5). In multivariable analyses, valuing a short hospital stay (odds ratio, 12.4; 95% confidence interval, 1.13-135.70) and valuing a shorter recovery (odds ratio, 15.72; 95% confidence interval, 1.03-240.20) were associated with a greater odds of preference for EVAR, whereas finding these characteristics not important was associated with a greater odds of preference for open repair. When faced with the decision of open repair versus EVAR, veterans who valued a shorter hospital stay and a shorter recovery were more likely to prefer EVAR, whereas those more concerned about long-term complications preferred an open repair. Veterans typically value the advice of their surgeon over their own beliefs and preferences. These findings need to be considered by surgeons as they guide their patients to a shared decision.

Impact of iatrogenic post-cholecystectomy biliary duct injury on quantity of diagnostic imaging and hospital re-admission

Abstract Although the risk of persistent biliary duct injury is low, cholecystectomy is one of the most commonly performed procedures worldwide. The occurrence of bile duct injury (BDI) results in complicated reconstructions, prolonged hospitalisation, repeated diagnostic examinations, and a high risk of long-term complications, leading to cost increase. A wide range of diagnostic methods are used to identify the damage and the associated complications. The aim of the study was to evaluate the impact of iatrogenic post-cholecystectomy BDI on the amount of diagnostic imaging and hospital re-admission rate. The retrospective cross-sectional study included the analysis of records of 38 patients undergoing laparoscopic cholecystectomy, referred to the Diagnostic Radiology Institute, Pauls Stradiņš Clinical University Hospital, who underwent diagnostic imaging. Among those who had iatrogenic BDI due to cholecystectomy, 57.9% (22 patients) underwent abdominal ultrasonography, 47.4% (18 patients) underwent endoscopic retrograde cholangiopancreatography, 47.4% (18 patients) underwent percutaneous transhepatic cholangiography (PTCA), 44.7% (17 patients) underwent computed tomography, 42.1% (16 patients) underwent magnetic resonance imaging, 13.2% (five patients) underwent US-guided puncture after cholecystectomy, and 15.8% (six patients) underwent fistulography. 18.4% (seven patients) were re-admitted to hospital once due to post-cholecystectomy complications, 34.2% (13 patients) twice, 15.8% (six patients) three times, 5.3% (two patients) four times, 13.2% (five patients) five times, 2.6% (one patient) seven times, 2.6% (one patient) ten times, 5.3% (two patients) eleven times and 2.6% (one patient) was re-admitted twenty-five times. Statistically significant strong correlation between hospital re-admission rate and PTCA (rs = 0.682, p &lt; 0.001) was found. Iatrogenic post-cholecystectomy BDI significantly affects repeated diagnostic imaging and the hospital re-admission rate and, therefore, negatively affects hospital economics and patient welfare.

A Comprehensive Review of Dietary Factors Involved in Aetiology and Prevention of Cancer

Cancer has emerged as far more common disease than what it was once considered. An alarming increase in the incidence of cancer in recent years is a cause of major concern. Sedentary lifestyle, consumption of processed foods, alcohol, increasingly stressful life and smoking is considered to be contributory factors. Diet among all these factors has close association with the health of an individual. Increasing evidences have associated certain food ingredients and their addictions as risk factors for development of cancer. Similarly, millions of investigations have pointed out the role of specific nutrient in the diet in blocking specific cancer cell growth pathways. Present paper reviews the influence of dietary factors in the aetiology of cancer. It discusses the role of intermediate metabolites released in triggering transformation of cells. The paper further elaborates on the potential of various dietary components in prevention of cancer, improving effectivity of chemotherapy treatment and lowering the risk of long-term complications in cancer patients. This knowledge is important in making decisions regarding both individual’s dietary choices and shaping health promoting policies. Keywords: Chronic, Prevalence, N-nitroso compounds, Dietary, Phytochemical

Abstract 14184: Outcomes of Transcatheter Aortic Valve Implantation in Patients With Severe Morbid Obesity

Introduction: The long-term effects of severe obesity [body mass index (BMI) ≥50 kg/m 2 ) on the outcomes of Transcatheter Aortic Valve implantation (TAVI) remains unknown. Methods: The National Readmission Database (NRD) was used from 2015-2019 to identify all patients undergoing TAVI. Patients with severe obesity were compared with those having BMI &lt;50 kg/m 2 . The adjusted odds ratios (aOR) and 95% confidence interval (CI) were calculated using a propensity-score matched analysis (PSM).(Fig 1) Results: A total of 184,199 patients were included in the crude analysis. A selected sample of 4669 [2369 (50.7%) severely obese, and non-obese 2300 (49.3%)] were included in PSM analysis. At index admission, the adjusted odds of net adverse clinical events (NACE) (aOR 1.57, 95% CI 1.12 -2.20, p=0.01), all-cause in-hospital mortality (aOR 8.08, 95% CI 3.19-20.48, p=&lt;0.0001), and acute kidney injury were (aOR 1.48, 95% CI 1.25-1.74, p=&lt;0.0001) were significantly higher in severely obese patients compared with those having with BMI&lt;50 kg/m 2 . There was no difference in stroke (aOR 0.60, 95% CI 0.32-1.11, p=0.14), or major bleeding (aOR 1.63, 1.01-2.64, p=0.06) between the two groups. At 30- and 180-day, there was no significant difference in the incidence of stroke, or major bleeding between the two groups.(Fig 2) There was a steep increase in the utilization of TAVI in severely obese patients from 17.6% to 31.8% per total procedures during 2016 to 2019. Conclusions: Severely obese (BMI ≥50 kg/m 2) recipients of TAVI have a higher risk of NACE and mortality, however, there appearsto be no significant difference in the long-term risk of complications between severely obese and non-obese patients.

Acute Myocardial Infarction in a 13-Year-Old Boy after Bone Marrow Transplantation

BackgroundAdvances in bone marrow transplantation (BMT) present a unique opportunity for treating leukemia in children. It has also increased the risk of long-term complications in the lungs, genitourinary tract, and nervous system. Coronary artery disease is the most common type of heart disease in older adults, but is not generally acknowledged as a complication of BMT, especially in young patients. Case ReportWe report the occurrence of acute myocardial infarction in a 13-year-old boy, approximately 5 years after he received a half-matched related bone marrow transplant from his father for T-cell lymphoblastic leukemia. Acute myocarditis was suspected early in the clinical course on the basis of his age and clinical presentations, such as atypical chest pain and dyspnea. Follow-up coronary angiography revealed a total occlusion of the right coronary artery, as well as diffused lesions of the left main, anterior descending, and circumflex branch. Fortunately, he was discharged from the hospital in satisfactory general condition after complex treatment.Why Should An Emergency Physician Be Aware of This? In this case, its rarity and poor clinical recognition were the main reasons for delayed diagnosis, which led to a delay to coronary angiography. Given the high mortality in cardiovascular complications among BMT recipients, the correct diagnostic assessment in such cases becomes particularly relevant.

Knowledge of Household Contacts of Diabetic Patients about the Disease

Background: Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patients and their household care givers self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications&#x0D; Objectives: To assess the knowledge of household contacts about different aspects of diabetes and determine factors affecting it.&#x0D; Subjects and methods: Cross sectional analytic design was conducted in Buraidah city, North central Saudi Arabia among a sample of household contacts of diabetic patients (Type 1 or 2) attending Buraidah diabetic center throughout the period of the study. A valid self-administered questionnaire including question about socio-demographic characteristics of the participants, patient’s diabetic characteristics and knowledge questions regarding diabetes was used for data collection.&#x0D; Results: The study included 422 household contacts of diabetic patients. The age of 44% of the participants was ranging between 20 and 39 years. Females represent 55.2% of them. Almost two-thirds of the participants (64.4%) expressed adequate level of knowledge about diabetes whereas 12.6% had poor level of knowledge. Their main source of information about diabetes was physicians (56.9%), followed by books/social media (23.9%). Household contacts aged between 20 and 39 years, singles, postgraduate educated, working, being sons and parents of patients were more knowledgeable about diabetes compared to their counterparts. Participants whose patients had more duration of diabetes, family support, and no foot fungal infection were more knowledgeable about the disease. With increasing in the level of HbA1c% among diabetic patients, the knowledge of household contacts about the disease decreased, p&lt;0.001.&#x0D; Conclusion: Knowledge of household contacts of diabetic patients in Buraidh city, Saudi Arabia about diabetes was overall adequate with some identified deficient facts. The increase in the level of knowledge was accompanied with more glycemic control.

OR29-5 Phase 3 PaTHway Trial: Participants Treated With TransCon PTH Achieved Independence From Conventional Therapy While Maintaining Normal Serum Calcium

Abstract Background Adults with chronic hypoparathyroidism managed with conventional therapy (calcitriol, alfacalcidol, and oral calcium) generally report a reduced quality of life (QoL) and remain at risk for long-term complications from abnormal calcium and phosphate metabolism. The PaTHway trial assessed the efficacy and safety of TransCon PTH at Week 26. Methods PaTHway was a double-blind, placebo-controlled 26-week trial with 3: 1 randomization to TransCon PTH 18 mcg/d or placebo, co-administered with conventional therapy. The composite primary efficacy endpoint was the proportion of participants at Week 26 who achieved: serum calcium levels in the normal range (8.3–10.6 mg/dL), independence from conventional therapy defined as requiring no active vitamin D and ≤600 mg/day of calcium supplementation, and no increase in prescribed study drug over 4 weeks prior to Week 26. Key secondary endpoints included Hypoparathyroidism Patient Experience Scale (HPES) domain scores and 36-Item Short Form Survey (SF-36) subscale scores. Results 82 participants were dosed (78% female, mean age 49 years). 79 completed treatment through Week 26. 79% (48/61) of participants randomized to TransCon PTH met the composite primary efficacy endpoint, compared to 5% (1/21) in the placebo group (p &amp;lt;0.0001). 93% (57/61) participants treated with TransCon PTH achieved independence from conventional therapy. At baseline, mean serum calcium was 8.8 and 8.7 mg/dL for TransCon PTH and placebo respectively; 8.9 mg/dL and 8.2 mg/dL at Week 26, respectively. For TransCon PTH, mean urine calcium decreased significantly from 390 mg/24-hour at baseline to 220 mg/24-hour (normal range &amp;lt;250 mg/24-hour) at Week 26 compared to 329 mg/24-hour at baseline to 292 mg/24-hour at Week 26 for placebo. TransCon PTH therapy demonstrated a significant improvement in HPES-Symptom domain scores − Physical (p = 0.0038) and Cognitive (p = 0.0055), HPES-Impact domain scores − Physical Functioning (p = 0.0046) and Daily Life (p = 0.0061), and SF-36 Physical Functioning subscale score (p = 0.0347) compared to placebo. Overall, TransCon PTH was well-tolerated. The majority of adverse events (AE) were mild or moderate in severity. The most commonly reported study drug-related AEs were injection site reactions, hypercalcemia, and headaches. No study drug-related AEs led to withdrawal from the study. Conclusions In the PaTHway phase 3 trial, 79% of participants on TransCon PTH therapy (versus 5% on placebo) were able to achieve independence from conventional therapy while maintaining normocalcemia at Week 26. Uniquely, TransCon PTH therapy decreased and normalized 24-hour urine calcium excretion and significantly improved QoL (symptom burden and impact) from baseline compared to placebo. These data suggest the potential for TransCon PTH to improve clinical outcomes and QoL compared to current conventional therapy. Presentation: Tuesday, June 14, 2022 10:45 a.m. - 11:00 a.m.

ODP220 Latent Autoimmune Diabetes of Adults and PCOS - an Unusual Combination

Abstract Introduction Latent autoimmune diabetes of adults (LADA) is an adult-onset subtype of autoimmune type 1 diabetes mellitus (T1DM), that is often misdiagnosed as T2DM. We present a case of LADA that was diagnosed in a young female with PCOS (polycystic ovaries syndrome) previously unsuccessfully managed as a T2DM patient. Case report 20-years-old female with past medical history of hyperlipidemia, newly diagnosed PCOS and suspected T2DM, presented to the PCP office for a routine follow up. Patient medication regimen consisted of Metformin 500 mg BID, Spironolactone 50 mg daily and oral contraceptive. Her BMI was 27.1. Routine blood work resulted in A1C 12.6% (estimated average glucose of 306 mg/dL), total cholesterol 278 mg/dL, triglycerides 1216 mg/dL, HDL cholesterol 31 mg/dL. She was also found to be Vitamin D deficient (Vitamin D, 25-OH 9.8 ng/mL). Based on a very young age and unusually elevated A1C she was assessed for LADA and found to have glutamic acid decarboxylase antibody (GAD-65) titer greater than 28.9 IU/mL (normal 0 - 5. 0 IU/mL), C-peptide of 0.8 ng/mL (normal 0.8-3.5 ng/mL) and negative anti pancreatic islet cells antibody level. Based on those results, she was diagnosed with LADA and initiated on insulin therapy (long acting and short - acting mealtime insulin). Metformin and OCP were discontinued given very high cholesterol level, but she started on Fenofibrate 160 mg daily, Vitamin D supplements and continued with Spironolactone 50 mg daily. Within 3 months her HbA1c decreased to 6.9% and she is doing remarkably well with the new medication regimen. Discussion LADA shares similar genetic and autoimmune profiles with T1DM, however LADA insidious presentation overlaps with T2DM, often resulting in misdiagnosis and delaying diagnosis and adequate treatment. Insulin resistance appears to underlie many of the endocrine features of PCOS in most of the patients. The risk of T2DM among PCOS patients is 5- to 10-fold higher than normal, however there is no clear correlation established between PCOS and T1DM, including LADA. Our case warrants newly diagnosed young adults with diabetes should be screened for LADA if there are atypical findings (such as very young age, remarkably elevated A1C, close to normal BMI). Among the anti-islet antibodies, GAD-65 are the most sensitive self-antigen-antibody markers of autoimmune diabetes. Early insulin therapy preserves residual β-cell function, improves glycemic control, and reduces the risk of long-term complications. Presentation: No date and time listed